One woman is now sharing her story after she had her breast implants removed and discovered one was filled with mold. Melissa Lima had been experiencing a range of symptoms, including depression and joint pain, but it took her years to discover she may have been, in part, suffering from breast implant illness (BII).

Lima recently explaining that she’d gotten saline breast implants in 2002 (which she’d had redone in 2005 for a smaller size). By 2010, she said she experienced various symptoms, including severe joint pain, depression, and inflammation. She told that she’d also been diagnosed with Hashimoto’s disease. 

Lima said doctors never considered her breast implants when she complained of the above-mentioned symptoms. In 2020, she underwent explantation and discovered her left implant was filled with mold. Lima told Buzzfeed she feels 90 percent better. “My face and eyes literally changed within hours,” she said. She still has and treats Hashimoto’s. disease. 

 Constance M. Chen MD, board-certified plastic surgeon and breast reconstruction specialist, says patients with BII may present with a wide range of symptoms, including “brain fog, joint aches, hair loss, swelling, visual changes, fatigue, strange body odors, skin changes such as rashes or discolored skin, nail changes (such as thick or black fingernails resistant to any antifungal treatments), breathing problems, heart palpitations, and distorted taste buds.” 

 

BII: Is it real?

 

Lima’s story echoes others who believe BII is responsible for some illnesses. With hundreds of support groups and recent clinical research around the condition, discussion around BII is growing.

Habib PM, Serena T, Derosa A. Breast implant illness: a case series. Cureus. 14(3):e23680.

 

 

Still, BII is something more physicians and researchers are looking closely at. According to Joshua Lampert, MD, FACS, a Miami, Florida-based surgeon who specializes in breast surgery, BII wasn’t something many doctors considered “real” even a decade ago—but he says the tides have turned. “Now, it’s become more and more of a common subject of publication and presentation at national meetings,” he says.

What he has seen in his practice is also compelling. “I noticed that a lot of patients felt a lot better [after explantation],” Lampert says. “Patients who had rheumatoid arthritis or lupus were doing better. Patients with platelet deficiencies were doing better. Or patients’ period cycles became regular after removal. More often, it was patients coming back and saying they felt so much better. When you have a lot of patients saying that, it’s hard to not believe it.”

 

A closer look at BII, mold, and breast implants

 

Is it the mold or the implant itself that causes BII? Chen believes it’s the implant. 

“Mold would 100 percent cause illness, but I believe that breast implant illness is caused by breast implants themselves without mold,” Chen says. Lampert agrees, adding that capsular contracture, for example, may also cause a subclinical, chronic inflammatory state. Clinical articles have also investigated “silicone implant illness” and potential associations between breast implants and connective tissue disorder.

Kaplan J, Rohrich R. Breast implant illness: a topic in review. Gland Surg. 2021;10(1):430-443.

 

 

But what about mold? There is currently no clinical evidence that mold is directly associated with BII, but it has been shown to cause post-breast implantation infections. According to a case report in JPRAS Open, a 53-year-old immunocompetent patient sought elective removal of breast implants, which she’d had five years earlier.

Koan C, Venegas RJ, Murphy RA. A surprising complication of breast augmentation surgery. JPRAS Open. 2021;31:62-66.

 

 

The case report says that shortly after the implant surgery, she reported developing diffuse joint pain as well as “intermittent bilateral pain, warmth, and pruritus involving both breasts….[and] reported breast erythema that extended to the bilateral upper extremities.” 

The report found that the patient was exposed to Scedosporium apiospermum, an opportunistic fungal pathogen at the time of surgery, which was assumed to have caused a late-onset infection.

“Breast implant-associated infections are rarely caused by mold, but cases involving a variety of fungal organisms including Aspergillus spp., Candida spp., and Trichosporon have been described,” the report also said. 

Lampert explains that implants can be contaminated by mold when a surgeon doesn’t use a sterile, closed-fill technique to inflate a saline implant. 

 

When should you recommend a patient have an explant?

 

Lampert recommends spending time with your patient to see if explantation is right for them. 

Chen says the typical patient with BII may have already seen numerous specialists before sitting in your office. They may have seen rheumatologists, neurologists, cardiologists, and pulmonologists—and have likely had several tests. These may include MRIs, CT scans, EEGs, and lab work. These tests, she says, usually come up negative.

At this point, Chen adds, “[The patient] is finally wondering whether their breast implants could be causing their problems. By the time patients remove their breast implants, they have typically exhausted all other diagnoses.” 

Her advice to physicians? “If you suspect breast implant illness, refer your patient to a plastic surgeon—ideally a plastic surgeon who is experienced in removing breast implants with a complete en bloc capsulectomy so that all of the scar tissue around the breast implant is also removed.”